On Fri, May 1, 2009 at 9:21 PM, Robert Munn <[email protected]> wrote: > Bingo. Ironically, our affluence means there are enough people willing to > pay out of pocket for most medical care that doctors increasingly refuse to > accept insurance altogether. Those folks will never join a single payer > system, so we'll end up with a chronically understaffed public health system > and an excellent private pay system where all the best doctors work.
An interesting idea but I don't believe you have any data to back up your assertion. "Increasingly refuse to accept insurance all together"? That is laughable. There are such practices out there, I'll grant you. They number in the 10's. Maybe 100's even now. Almost all in affluent big cities. It is not a trend going anywhere I assure you. Now, there is an interesting trend of practices which charge a yearly "membership" fee that allows them to keep patient loads low and provide additional services such as email consultation which insurance doesn't generally cover. Boy, you want a clusterfuck of a fight, try to figure out the rules insurance companies have regarding what is classifiable as a "medical encounter" over email or phone. I belong to one such medical group and pay an extra fee each year in order to deal with thing the way I think a patient-doctor relationship ought to. They also accept my insurance and bill it for all items not covered by my annual fee (copays for instance are not collected by them and are considered covered under my annual fee). I do strongly feel that such innovations ought to be allowed and encouraged under any health care reform plan offered up in Congress. I really don't think you have any concept of what doctors want. Doctors, for the most part, want to make a decent living and provide good medical care for their patients. That's it. The insurance "system" we have in place now is an impediment to that for the most part. To the extent we can make it so that they have to spend less time with administration, billing, accounting, UCR writeoffs, blah blah blah and more time helping keep people healthy, they are going to be stoked. That is one of the goals of a single payer system. Consistent rules, streamlined billing, fewer gotchas. That, ideally, will allow them to spend more time on medicine and less on business, which is something I think we should all be rooting for. I spend a lot of time talking to medical billing folks. I'm doing my best to make their lives easier and the lives of patients easier. But the system is a genuine clusterfuck. I don't have any illusions that a single payer system would magically make everything totally streamlined and efficient and overhead would go down to the lowest possible denominator. Government can certainly complicate things as well as streamline them. Hell, look at the tax code. But seriously, if you had any real interaction with the maze that is health insurance and medical billing, you'd want to take King Solomon's way out of the dilemma. I applaud Obama for recognizing that the system needs a pragmatic approach. I disagree with those that say a single payer system is inherently unpragmatic. I suspect that the best answer, which is what I see being espoused by many of the single payer believers, is that the best option at this point is a mix of private insurance (which I'd never want to see that option go away) and a robust public option. Private insurance doesn't want to compete with a publicly available plan. But fuck them, we don't owe them a profit. The duty here is to the people, not to the industry sector. Offer a robust public plan option and let private insurance compete as they will and find their niches. Judah ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Adobe® ColdFusion® 8 software 8 is the most important and dramatic release to date Get the Free Trial http://ad.doubleclick.net/clk;207172674;29440083;f Archive: http://www.houseoffusion.com/groups/cf-community/message.cfm/messageid:296626 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/cf_lists/unsubscribe.cfm?user=89.70.5
